Association Between Psychotic and Dissociative Symptoms: Further Investigation Using Network Analysis.

The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed.

Prevalence and Phenomenology of Sensory Experiences of a Deceased Spouse: A Survey of Bereaved Older Adults.

Sensory and quasi-sensory experiences of the deceased (SED), also called bereavement hallucinations, are common in bereavement, but research detailing these experiences is limited. Methods: An in-depth survey of SED was developed based on existing research, and 310 older adults from the general Danish population participated in the study 6-10 months after their spouse died. Results: SED were reported by 42% of the participants with wide-ranging phenomenological features across sensory-modalities. In particular, seeing and hearing the deceased spouse was experienced as very similar to the couple's everyday contacts before death. SED were endorsed as positive by a majority of experiencers, and the experiences were often shared with family and friends. Discussion: SED are conceptualized as social and relational phenomena, which may comfort the surviving spouse in late-life bereavement, but also provide tangible help to some experiencers. In clinical practice, SED may be considered a potential resource for the therapeutic grief process.

Sensory experiences of one's deceased spouse in older adults: An analysis of predisposing factors.

Objectives This study focuses on pre-disposing factors associated with sensory experiences of the deceased (SED), also called bereavement hallucinations. Even though SED are common among older widowed adults, our knowledge of these experiences is still limited.Method Survey responses were obtained from 310 older widowed participants (M = 70.05 ± 8.39), complemented with data from Danish national registers.Results Hierarchical logistic regression analysis revealed four significant pre-disposing factors: prior experiences of SED in the context of previous significant bereavements (OR = 4.72), a history of interpersonal trauma (OR = 5.8), high pre-death relationship closeness (OR = 2.76) and stronger religious/spiritual worldview (OR = 1.12). No association to registered mental health diagnosis was identified.Conclusion: SED may be considered an interpersonal experience, which may be more likely to occur if the pre-death relationship is described as very close and if the bereaved has previously experienced interpersonal trauma. We argue that SED should not necessarily be considered an indication of neurodegenerative or psychiatric diseases.

Are Sensory Experiences of One's Deceased Spouse Associated with Bereavement-Related Distress?

Following late-life spousal bereavement, sensory and quasi-sensory experiences of the deceased (SED) are commonly reported. This longitudinal study examined SED among 310 older widowed adults 6-10 (T1) and 18-20 (T2) months post loss. Reports of SED in the first 6-10 months after loss were associated with higher symptom levels of prolonged grief, post-traumatic stress, and loneliness at T1. Experiencers of SED were more likely to experience symptoms of prolonged grief and post-traumatic stress above cut-off scores at T1. Importantly, only a minority of the experiencers of SED displayed these elevated levels of bereavement-related distress. In addition, employing multi-level-modeling, a similar trajectory of decreasing bereavement-related distress over time was found for both experiencers and non-experiencers of SED. We argue that SED may be one of several potential reactions to bereavement, which should not be seen as an indicator of grief complications per se.

Do Treatment Plans Matter? Moving From Recommendations to Action.

We investigated whether a service-planning document outlining recommendations for what providers should address in treatment (i.e., targets) and the associated clinical techniques they should employ (i.e., practices) influenced the targets and practices that providers reported actually implementing during the subsequent treatment episode. Participants included 94 youths ages 4 to 17 (M = 13.57, SD = 3.59) who received community-based mental health services from the Hawai'i Child and Adolescent Mental Health Division. Data on targets and practices were compared across initial Mental Health Treatment Plans and Monthly Treatment and Progress Summaries. Data were analyzed using two-level, generalized mixed effects models with two-way cross-classification or linear mixed effects models. Providers were more likely to report the use of targets and practices in treatment if they were included within the treatment plan. In addition, the more closely targets addressed during treatment followed the recommended targets from the treatment plan, the more closely implemented practices followed the recommended practices listed in the treatment plan. Furthermore, as providers shifted their focus to different targets, a shift in their use of practices was also evident over time. Last, practices for which there is demonstrated efficacy for particular targets were more likely to be used. Service planning documents appear to help organize care; however, results also suggest possible limitations to the current system. These findings highlight potential areas for improvement in planning and care delivery.

Bereavement hallucinations after the loss of a spouse: Associations with psychopathological measures, personality and coping style.

Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants 4 years post loss, to explore whether BHs were: (a) associated with psychological distress and (b) predicted by sociodemographic variables, personality and/or coping style. Participants with BHs scored significantly higher than those without BHs on prolonged grief, post-traumatic stress, depression symptoms, and emotional loneliness. Hierarchical logistic regression analysis showed avoidant coping, openness to experience, and length of marriage to significantly predict BHs, while detached coping was negatively associated with BHs. This study suggests that BHs may be an indicator of psychological distress in bereavement.

Community-Based Providers' Selection of Practices for Children and Adolescents With Comorbid Mental Health Problems.

The goal of this study is to explore providers' patterns of implementation by investigating how community mental health providers selected therapy practice modules from a flexible, modular evidence-based treatment working with youths with comorbid mental health problems. Data were obtained from 57 youths, 5-15 years old, presenting with anxiety, depressive, and/or conduct problems and their 27 providers during their participation in an effectiveness trial involving a modular evidence-based treatment. Although all youths evidenced clinically elevated symptomatology in at least two problem areas, providers targeted youths' comorbid problems with only about half of their study cases. Practice modules indicated for youths' comorbid problems were typically used less frequently and with less depth relative to practice modules indicated for youths' principal clinical problem and were often transdiagnostic in nature (i.e., designed to target more than one problem area). To determine whether providers' decisions to target youths' comorbid problems were systematic, multilevel, logistic regression analyses were conducted and revealed that youths' pretreatment characteristics and time in therapy influenced providers' patterns of module selection. Providers tend to use, but not exploit, the flexibility allowed by modular EBTs and to focus treatment on youths' principal presenting problem. In addition, providers appear to make these practice choices in a systematic and rational manner, and whether and which choices are associated with improved outcomes is an important area of future study.

Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences.

Exposure to childhood trauma has been implicated in the development of paranoia and hearing voices, but the mechanisms responsible for these associations remain unclear. Understanding these mechanisms is essential for ensuring that targeted interventions can be developed to better support people experiencing distress associated with paranoia and voices. Recent models have proposed that dissociation may be a mechanism specifically involved in the development of voices and insecure attachment in the development of paranoia. Recent theoretical proposals have added to this and argued that fearful attachment could also lead to increased vulnerability for voices. This study was the first to examine whether dissociation and insecure attachment styles mediated the relationship between childhood trauma and these psychotic experiences. One hundred and twelve participants experiencing clinical levels of psychosis completed measures of dissociation, childhood trauma, attachment, voices, and paranoia. Results revealed positive associations between fearful (but not dismissive and anxious) attachment, dissociation, trauma, and psychotic experiences. Mediation analyses indicated that dissociation, but not fearful attachment, significantly mediated the relationship between trauma and voices. Conversely, both dissociation and fearful attachment significantly mediated the relationship between trauma and paranoia. The findings suggest that insecure attachment might be more strongly related to paranoia than hallucinations and suggest that fearful attachment may be a more promising mechanism to explain this relationship. Furthermore, the findings suggest that the impact of dissociation on psychotic experiences may extend to paranoia. Future research is required to replicate these findings using interview-based attachment measures.

Positive Affect and Inflammatory Activity in Breast Cancer Survivors: Examining the Role of Affective Arousal.

OBJECTIVE: Given the importance of positive affect and inflammation for well-being in cancer survivors, the current study examined the relationship between high- and low-arousal positive affect and inflammation in 186 women who completed treatment of early-stage breast cancer. METHODS: Measures of high- and low-arousal positive affect were completed within 3 months after treatment completion (baseline). Plasma markers of inflammation, including soluble tumor necrosis factor receptor type II (sTNF-RII), C-reactive protein (CRP), and interleukin-1 receptor antagonist, were assessed at baseline and 6- and 12-month follow-up assessments. RESULTS: Multilevel modeling analyses showed that high-arousal positive affect was associated with lower levels of sTNF-RII, a marker of TNF activity, at treatment completion and prospectively predicted maintenance of these differences through the 6- and 12-month follow-ups adjusting for biobehavioral confounds (b = -0.055, t(156) = -2.40, p = .018). However, this association was no longer significant when adjusting for fatigue. Exploratory analyses showed that low-arousal positive affect was associated with lower levels of CRP at treatment completion and through the 6- and 12-month follow-ups; this association remained significant after adjusting for fatigue and other confounds (b = -0.217, t(152) = -2.04, p = .043). CONCLUSIONS: The relationship of high-arousal positive affect (e.g., "active") with sTNF-RII seems to be driven by the overlap of high-arousal positive affect with fatigue, whereas the relationship of low-arousal positive affect (e.g., "calm") with CRP was independent of fatigue. Future research should consider affective arousal when examining the association of positive affect with inflammation as this facet of positive affect may have important implications for interpretation of results.

Personality disorders and the DSM-5: Scientific and extra-scientific factors in the maintenance of the status quo.

OBJECTIVE: The aim of this study was to review and discuss the evidence for dimensional classification of personality disorders and the historical and sociological bases of psychiatric nosology and research. METHOD: Categorical and dimensional conceptualisations of personality disorder are reviewed, with a focus on the Diagnostic and Statistical Manual of Mental Disorders-system's categorisation and the Five-Factor Model of personality. This frames the events leading up to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, personality disorder debacle, where the implementation of a hybrid model was blocked in a last-minute intervention by the American Psychiatric Association Board of Trustees. Explanations for these events are discussed, including the existence of invisible colleges of researchers and the fear of risking a 'scientific revolution' in psychiatry. RESULTS: A failure to recognise extra-scientific factors at work in classification of mental illness can have a profound and long-lasting influence on psychiatric nosology. In the end it was not scientific factors that led to the failure of the hybrid model of personality disorders, but opposing forces within the mental health community in general and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Task Force in particular. CONCLUSION: Substantial evidence has accrued over the past decades in support of a dimensional model of personality disorders. The events surrounding the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Personality and Personality Disorders Work Group show the difficulties in reconciling two different worldviews with a hybrid model. They also indicate the future of a psychiatric nosology that will be increasingly concerned with dimensional classification of mental illness. As such, the road is paved for more substantial changes to personality disorder classification in the International Classification of Diseases, 11th Revision, in 2017.

Interpreting Progress Feedback to Guide Clinical Decision-Making in Children's Mental Health Services.

Measurement feedback systems (MFSs) can help improve clinical outcomes by enhancing clinical decision-making. Unfortunately, limited information exists to guide the use and interpretation of data from MFSs. This study examined the amount of data that would provide a reasonable and reliable prediction of a client's rate of symptomatology in order to help inform clinical decision-making processes. Results showed that use of more data predicted greater levels of accuracy. However, there were diminishing returns on the ability for additional data to improve predictive accuracy. Findings inform efforts to develop guidelines on the interpretation of data from MFSs.

Young Athletes program: impact on motor development.

This study examined the effectiveness of the Young Athletes program to promote motor development in preschool-aged children with disabilities. In the study, 233 children were randomly assigned to a control group or the Young Athletes (YA) intervention group which consisted of 24 motor skill lessons delivered 3 times per week for 8 weeks. Hierarchical Linear Modeling (HLM) showed that children who participated in the YA intervention exhibited mean gains of 7-9 months on the Peabody Developmental Motor Subscales (PDMS) compared with mean gains of 3-5 months for the control group. Children in the YA intervention also exhibited significant gains on the gross motor subscale of the Vineland Teacher Rating Form (VTRF). Teachers and parents reported benefits for children not only in specific motor skills, but also kindergarten readiness skills and social/play skills. The necessity for direct and intentional instruction of motor skills, as well as the challenges of involving families in the YA program, are discussed.

The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis.

Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 -.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 -.531), delusions (r = .418; 95%CI: .370 -.464), paranoia (r = .447; 95%CI: .393 -.499), and disorganization (r = .346; 95%CI: .249 -.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.

Schizophrenia and dissociation: Its relation with severity, self-esteem and awareness of illness.

This article describes the conclusions of an investigation done with 120 Spanish patients: the finding of a new psychopathological profile within a subgroup of patients suffering from schizophrenia. The patients were evaluated through different questionnaires about sociodemographic data, traumatic events, the severity index (both clinical and psychopathological), self-esteem and consciousness of the illness. From the scores obtained on a scale of dissociative experiences, they were classified into two groups: high dissociative symptomatology or HD, and low dissociative symptomatology or LD. The HD group contained 44 patients (36.7% of the total population). The groups LD and HD show meaningful differences with respect to dissociative symptomatology levels, general psychopathology and level of traumatic events suffered. The percentage of patients with low self-esteem was higher in group HD than in group LD (M=25.52 front 28.76 of group LD; t (118)=2.94, p=.00). In addition, the group HD was more conscious of having a mental disorder, of the beneficial effects of medication and of the social consequences of their illness: F (1)=10.929, p=.001; ƞ2pt=0.083; 1-ß=0.907. The results show the existence of a subgroup of schizophrenic patients with higher levels of dissociation and trauma that were related with higher levels of symptomatology, lower self-esteem and higher consciousness of the illness, building a population of higher severity in which it would make sense to implement coadjutant treatments specifically oriented to these variables and, in addition, opening a therapeutic possibility for the patients with refractory schizophrenia.

Distinctive Trajectories of Opioid Use Over an Extended Follow-up of Patients in a Multisite Trial on Buprenorphine + Naloxone and Methadone.

OBJECTIVES: Uncovering heterogeneities in longitudinal patterns (trajectories) of opioid use among individuals with opioid use disorder can increase our understanding of disease progression and treatment responses to improve care. The present study aims to identify distinctive opioid use trajectories and factors associated with these patterns among participants randomized to treatment with methadone (MET) or buprenorphine + naloxone (BUP). METHODS: Growth mixture modeling was applied to identify distinctive opioid use trajectories among 795 opioid users after their enrollment in a multisite trial during 2006 to 2009, with follow-up interviews conducted during 2011 to 2014. RESULTS: Four distinctive trajectories were identified based on opioid use over the follow-up period: low use (42.0%), high use (22.3%), increasing use (17.1%), and decreasing use (18.6%). Greater odds of being in the high use group (relative to low use) was associated with Hispanics (relative to African American, odds ratio [OR] 3.21), injection drug use (OR 2.12), higher mental health functioning at baseline (OR 1.23), location on the West Coast (vs East Coast, OR 2.15), and randomization to BUP (relative to MET, OR 1.53). High use and increasing use groups had greater severity in problems related to drug, employment, legal, and social/family relationships, and worsened mental health functioning at follow-up. Participation in treatment significantly accounted for both within and between-group differences in opioid use. CONCLUSIONS: Continued treatment is necessary to reduce risk for opioid use and related adverse consequences, particularly among individuals (eg, injecting drug) at risk for consistently high level of opioid use.

Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review.

Schizophrenia spectrum disorders (SSDs) and dissociative disorders (DDs) are described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as 2 categorically distinct diagnostic categories. However, several studies indicate high levels of co-occurrence between these diagnostic groups, which might be explained by overlapping symptoms. The aim of this systematic review is to provide a comprehensive overview of the research concerning overlap and differences in symptoms between schizophrenia spectrum and DDs. For this purpose the PubMed, PsycINFO, and Web of Science databases were searched for relevant literature. The literature contained a large body of evidence showing the presence of symptoms of dissociation in SSDs. Although there are quantitative differences between diagnoses, overlapping symptoms are not limited to certain domains of dissociation, nor to nonpathological forms of dissociation. In addition, dissociation seems to be related to a history of trauma in SSDs, as is also seen in DDs. There is also evidence showing that positive and negative symptoms typically associated with schizophrenia may be present in DD. Implications of these results are discussed with regard to different models of psychopathology and clinical practice.

"Scared stiff": catatonia as an evolutionary-based fear response.

Catatonia, long viewed as a motor disorder, may be better understood as a fear response, akin to the animal defense strategy tonic immobility (after G. G. Gallup & J. D. Maser, 1977). This proposal, consistent with K. L. Kahlbaum's (1874/1973) original conception, is based on similarities between catatonia and tonic immobility ("death feint") as well as evidence that catatonia is associated with anxiety and agitated depression and responds dramatically to benzodiazepines. It is argued that catatonia originally derived from ancestral encounters with carnivores whose predatory instincts were triggered by movement but is now inappropriately expressed in very different modern threat situations. Found in a wide range of psychiatric and serious medical conditions, catatonia may represent a common "end state" response to feelings of imminent doom and can serve as a template to understand other psychiatric disorders.